俯卧人字位超声引导下可视穿刺辅助输尿管软镜治疗复杂型肾下盏结石的临床应用

Clinical application of flexible ureteroscopy combined with ultrasound guided all-seeing needle micro-PCNL in prone position for complex lower pole renal calculi

目的 评价俯卧人字位超声引导下可视穿刺辅助输尿管软镜治疗复杂型肾下盏结石的临床应用价值。方法 回顾性分析2018年4月至2019年10月单侧复杂型肾下盏结石65例患者的临床资料,俯卧位组32例采用俯卧人字位超声引导下可视穿刺辅助输尿管软镜钬激光碎石术治疗,截石位组33例采用截石位输尿管软镜钬激光碎石术治疗。比较两组手术时间、手术前后血红蛋白及血肌酐变化、术后降钙素原(PCT)、结石清除率、术后住院时间以及并发症发生率。结果 所有患者均完成手术治疗。俯卧位组较截石位组手术时间长(P=0.019)、结石清除率高(P=0.026),差异具有统计学意义(P<0.05);俯卧位组手术前后血红蛋白(P=0.207)及血肌酐变化(P=0.364)、术后PCT(P=0.187)、术后住院时间(P=0.168)、并发症发生率(P=0.149)与截石位组相比,差异无统计学意义(P>0.05)。结论 对于≤2cm的复杂型肾下盏结石患者,俯卧人字位超声引导下可视穿刺辅助输尿管软镜钬激光碎石术是一种安全有效的手术选择。

Objective To investigate the clinical application of flexible ureteroscopy combined with ultrasound-guided all-seeing needle micro-PCNL in prone position for complex lower pole renal calculi.Methods The clinical data of 65 patients treated during Apr.2018 and Oct.2019 were retrospectively analyzed,including 32 who received flexible ureteroscopic holmium laser lithotripsy combined with ultrasound-guided all-seeing needle micro-PCNL in prone position,and 33 who received flexible ureteroscopic holmium laser lithotripsy in lithotomy position.The operation time,changes of hemoglobin(Hb)and serum creatinine,postoperative procalcitonin(PCT),stone-free rate,postoperative hospital stay and incidence of complications were compared between the two groups.Results All operations were completed successfully.The operation time was significantly longer(P=0.019)and stone-free rate was significantly higher(P=0.026)in the prone position group than in the lithotomy position group.There were no statistically significant differences in changes of Hb(P=0.207)and serum creatinine(P=0.364),PCT(P=0.187),hospital stay(P=0.168)and incidence of complications(P=0.149)between the two groups.Conclusion Flexible ureteroscopic holmium laser lithotripsy combined with ultrasound-guided all-seeing needle micro-PCNL in prone position is safe and effective in patients with≤2 cm complex lower pole renal calculi.